急性腹膜炎护理个案分析.ppt

,急性腹膜炎护理个案分析,目录,健康评估,Background,Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients preferences. 。,相关知识,急性腹膜炎是由细菌感染，化学刺激或损伤所引起的外科常见的一种严重疾病。多数是继发性腹膜炎，原于腹腔的脏器感染，坏死穿孔、外伤等。其主要临床表现为腹痛、腹部压痛腹肌紧张，以及恶心，呕吐，发烧，白血球升高，严重时可致血压下降和全身中毒性反应，如未能及时治疗可死于中毒性休克。部分病人可并发盆腔脓肿，肠间脓肿、和膈下脓肿，髂窝脓肿、及粘连性肠梗阻等。,Background,Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients preferences. 。,相关知识,腹膜的生理功能： 润滑作用 防御作用 吸收作用 渗出与修复作用,Background,Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients preferences. 。,相关知识,Background,Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients preferences. 。,相关知识|分类,1.原发性腹膜炎 原发性腹膜炎临床上较少见，是指腹腔内无原发病灶，病原菌是经由血循、淋巴途径或女性生殖系等而感染腹腔所引起的腹膜炎。多见于体质衰弱，严重肝病患者或在抗病能力低下的情况下，或肾病、猩红热、营养不良并发上呼吸道感染时均可致病，尤其是10岁以下的女孩多见。脓液的性质椐菌种而不同，常见的溶血性链球菌的脓液稀薄而无臭味，脓汁和血培养可找到溶血性链球菌和肺炎双球菌。临床上常有急性腹痛、呕吐、腹泻，并迅速出现脱水或全身中毒症状。,Background,Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients preferences. 。,相关知识|分类,2.继发性腹膜炎 继发性腹膜炎是临床上最常见的急性腹膜炎，继发于腹腔内的脏器穿孔，脏器的损伤破裂，炎症和手术污染。主要常见病因有阑尾炎穿孔，胃及十二指肠溃疡急性穿孔，急性胆囊炎透壁性感染或穿孔，伤寒肠穿孔，以及急性胰腺炎，女性生殖器官化脓性炎症或产后感染等含有细菌之渗出液进入腹腔引起腹膜炎。绞窄性肠梗阻和肠系膜血管血栓形成引起肠坏死，细菌通过坏死之肠壁进入腹腔。导致腹膜炎。其他如腹部手术污染腹腔，胃肠道吻合口漏，以及腹壁之严重感染，均可导致腹膜炎。,Background,Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients preferences. 。,相关知识|临床表现,两大主要症状：腹痛、恶心呕吐 腹痛：最主要，持续性剧烈，腹压增加及体位变换可加重。病灶部位最为显著。 恶心、呕吐：早期反射性，晚期麻痹型呕吐。 全身中毒症状：体温升高，脉搏增快。全身感染中毒症状。,Background,Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients preferences. 。,相关知识|转归,一般年轻体壮者，抗病能力强，腹膜病变自行修复而痊愈 如果感染局限为膈下脓肿，盆腔脓肿则需切开引流 年老体弱，病变严重，治疗不当或不及时则感染可迅速扩散而形成弥漫性腹膜炎，或麻痹性肠梗阻 由于腹膜吸收了大量毒素以致发生中毒性休克，可导致多脏器衰竭,Background,Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients preferences. 。,相关知识|治疗,治疗原则上是积极消除引起腹膜炎的病因，并彻底清洗尽腹腔内存在的脓液和渗出液，或促使渗出液尽快吸收、局限。急性腹膜炎的治疗可分为非手术治疗和手术治疗两种。,Part 1,Background,Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients preferences. 。,一般资料,主诉：腹痛1日 现病史：患者自诉于2019年3月16日22点左右无明显诱因出现上腹部绞痛，呈持续性疼痛，无放射痛，伴恶心、非喷射性呕吐，呕吐物为胃内容物，无发热、寒战，疼痛不能忍受，休息后缓解不明显，自行购买药物治疗效果欠佳，今日就诊我院急诊科，给予完善上腹部CT提示：肝周少量积液，横结肠扩张积气，食管下段贲门处粘膜稍增厚，建议胃镜检查，腹部彩超提示腹腔积液。遂急诊以“腹痛”收入我科。病程中患者神志清，精神欠佳，急性病容，未进食水，睡眠差，有腹痛、腹胀，无发热、寒战，无反酸、烧心，无胸闷、心悸、气短，无咳嗽、咳痰，无嗳气、呃逆，无黄疸，小便正常，近期体重无明显改变。 体格检查：腹膜刺激征明显,入院评估,辅助检查,健康功能型态,健康功能与健康管理 营养代谢 排泄 活动运动 睡眠休息 认知感知 自我概念 角色关系 应对与应激耐受型态,Part 2,护理计划单,疼痛：与腹膜炎症刺激有关 营养失调：低于机体需要量 有体液不足的危险：与腹膜腔内大量渗出有关 知识缺乏：缺乏有关本病的病因和预防知识 心理护理 社会干预 相关护理措施,Part 2,健康教育,饮食指导：发病时患者应禁食